COVID 19: New and Updated Information and Resources
NJAASC has curated authoritative information and a list of resources for our Membership’s reference. We will continue to update this as more information becomes available.


PAST COVID E-BLAST HAVE BEEN ARCHIVED DUE TO SPACE RESTRAINTS AND TO KEEP THINGS CURRENT. 
TO VIEW PREVIOUS E-BLASTS, CLICK HERE

ELECTIVE PROCEDURE GUIDELINES -CONCERNS -5/20/20
NJAASC has submitted questions and concerns to the Department of Health regarding Tuesdays ASC guidelines.
We have meticulously gone over them and asked the Department for answers, further guidance and possible changes/amendments.

On Thursday at 2 PM NJAASC along with Brach Eichler and New Jersey Department of Health will be hosting a webinar regarding EO 145 guidelines.
Here is the link to register- and I would strongly suggest you submit any questions you have in advance per the instructions sent in the e-blast.

NEW JERSEY HEALTH CARE LEADERS TELL SENATE FISCAL RECOVERY COMMITTEE OF DIRE FINANCIAL IMPLICATIONS – 5/20/20
Yesterday the bi-partisan Senate Fiscal Recovery Committee held hearings from health care providers- including from  Jeff Shanton, President, NJAASC.


You can also go and watch/listen to it-we sent you the link in yesterday’s COVID e-blast. Go to the end to hear Jeff’s testimony.

EXPANSION OF COVID TESTING – 5/20/20
Yesterday it was announced that all 2,239 pharmacies in New Jersey may serve as testing sites. Licensed Pharmacists have been authorized to administer COVID tests. It was also announced that CVS pharmacies would be up and running at a minimum of 50 locations by the end of the month for this purpose. 
This is of course important in light of the testing requirements in the DOH guidelines for resuming surgeries, and the concern about adequate capacity.

     NEWARK – Attorney General Gurbir S. Grewal today announced that the Division of Consumer Affairs has authorized licensed New Jersey pharmacists to widely administer COVID-19 tests to customers, paving the way for thousands of pharmacies statewide to serve as testing sites.

     Expanding testing authority to the more than 18,000 pharmacists licensed in the state advances Governor Phil Murphy's goal of doubling statewide testing by the end of the month as part of his "Road Back" recovery plan to reopen the state.

     "Widespread testing is a vital component of Governor Murphy's strategy for reopening New Jersey and we are doing everything we can to facilitate expanded testing," said Attorney General Grewal. "With thousands of pharmacists now authorized to administer COVID-19 tests, finding a testing site in New Jersey will be as easy as walking to the corner drug store."

     There are 2,239 pharmacies in New Jersey, including retail chains and independent businesses.

     The Acting Director of the Division of Consumer Affairs last week signed an Administrative Order that permits licensed pharmacists to perform the tests at, or immediately outside of, a registered pharmacy. Under the Director's order, pharmacists may administer tests for COVID-19 or its antibodies without a prescription.

     "Neighborhood pharmacists are trusted members of their communities and are often a primary source of healthcare services and information for their customers," said Paul R. Rodriguez, Acting Director of the Division of Consumer Affairs. "This order provides New Jersey residents with easy access to safe, accurate testing administered by someone they know and trust,"

     The Administrative Order specifically allows pharmacists to order and perform tests, and waives legal requirements that otherwise would preclude pharmacists from administering tests without entering into a collaborative practice agreement or protocol with a physician.

     Under the Director's order, pharmacists may only perform tests that have been approved by the U.S. Food and Drug Administration ("FDA") or that have received an emergency use authorization issued by the FDA. Consumers are encouraged to ask about FDA approvals before submitting to a test.

     Including pharmacists in COVID-19 testing remains important, as the FDA has so far authorized only one at-home sample collection kit that can then be sent only to specified laboratories for COVID-19 diagnostic testing. That testing kit is authorized to be used by individuals at home only if they have been screened using an online questionnaire that is reviewed by a healthcare provider.

PPP UPDATE: LOAN FORGIVENESS APPLICATION FORM RELEASED BY THE SBA - 5/20/20
The long-awaited  loan forgiveness application form  from the Small Business Administration (SBA) under the Paycheck Protection Program (PPP) is now available. The form is 11 pages inclusive of instructions. Borrowers will need to work with their professionals to ensure submission of a complete and accurate forgiveness application. The key takeaways from the form are as follows:
  • Alternative Payroll Covered Period. Although the “covered period” for spending the money is still eight weeks from the day the borrower received the money, the SBA has provided borrowers with a biweekly or more frequent payroll an alternative payroll covered period. These borrowers will be permitted, for some aspects of forgiveness, to count the eight weeks from the first day of their first pay period following loan disbursement. 
  • Clarification of Eligible Payroll Costs and Timing of Payment. Although the statute states that it is costs that are “incurred and payments made” during the covered period, the SBA form requires that the payroll costs be paid or incurred during the covered period. The payroll is considered paid on the date the paycheck is distributed or the borrower originates an ACH credit transaction. The payroll is considered incurred on the date the employee’s pay is earned. And the borrower may include in its forgiveness amount payroll costs incurred but not paid during the last payroll of the covered period, provided the costs are paid on or before the next regular payroll date.
  • Clarification of Timing of Payment of Eligible Nonpayroll Costs. Although the statute states that it is costs that are “incurred and payments made” during the covered period, the SBA form requires that the nonpayroll costs must only be paid during the covered period, or incurred during the covered period and paid on or before the next regular billing date (even if it is after the covered period).
  • FTE Comparison Calculation. Although the statute does not define what an FTE is for purposes of the forgiveness calculation, the SBA form uses 40 hours a week as its standard. To determine how many FTEs your company has – for the covered period and for either of the two comparison periods at the company’s discretion – the employer can count employees who work 40 hours or more a week as 1 FTE and count the others as .5 FTE. Alternatively, the employer would enter the average number of hours per week, divide by 40, and round to the nearest tenth. This will determine whether the employer may lose forgiveness, in part, for a reduction in FTEs.
  • Salary/Hourly Wage Reduction Calculation. The SBA form confirms there will be a loss of forgiveness, in part, for any reduction in the total salary or wages of an employee (whose wages and salary did not exceed $100,000 in 2019) during the covered period in excess of 25% of the employee’s total salary or wages during the most recent full quarter (Q1 2020). The form provides a worksheet to perform this calculation.
  • Confirmation of June 30 Safe Harbor Deadline. The SBA form confirms that for any loss of forgiveness caused by either a reduction in FTEs or reduction in salary/hourly wages, occurring between February 15, 2020 and April 26, 2020, the employer will not lose forgiveness if the employer undoes these actions no later than June 30, 2020. The form also confirms that employers will not lose forgiveness for any employee who rejected a good-faith written offer to rehire the employee. Employers also will not lose forgiveness for any employee who, during the covered period, was fired for cause, voluntarily resigned, or voluntarily requested and received a reduction of their hours.
  • Documents Borrowers Must Submit With Their Forgiveness Application or Retain. The form provides a comprehensive list of documents borrowers must submit with their forgiveness application or retain for six years from the forgiveness determination. Borrowers will be required to permit SBA representatives, including representatives of the Office of Inspector General, to access the records upon request.
As always, we are here for you. If you have any questions about the loan forgiveness form or if we can assist in any other way, please reach out.
Matthew Collins , Member and Chair,  Labor and Employment Practice , at  mcollins@bracheichler.com  or 973-403-3151

DCA GUIDELINES FOR SERVICES IN HEALTHCARE PRACTICES -5/20/20
Attached are guidelines from Consumer Affairs for office services pursuant to EO 145. All ASCs should make sure their doctors read this.

NJDOH GUIDELINES FOR ELECTIVE SURGERY – 5/18/20
At the time of this e-blast, the guidelines have not been released by NJDOH.
By tomorrow we hopefully will have them, and be able to succinctly comment on them.
We will also be hosting a webinar on these guidelines on Thursday- stay tuned.

WHERE AND HOW DO I GET TESTED INFORMATION- 5/18/20
Here is link to NJ.Gov that answers questions, as we are approaching elective restart with testing.
Community based and local testing information available here, but not for private labs.


NJAASC PRESIDENT JEFF SHANTON TESTIFIES BEFORE SENATE FISCAL RECOVERY COMMITTEE- WATCH IT HERE -5/18/20
With Jeff Shanton appearing before the Senate fiscal recovery committee via Zoom, you can listen to the proceedings here:


Then click on the red button “Live proceedings”.

EO 145- RESUMING ELECTIVE SURGERIES – 5/18/20
EXECUTIVE ORDER NO. 145

     WHEREAS, in light of the dangers posed by Coronavirus disease 2019 ("COVID-19"), I issued Executive Order No. 103 (2020) on March 9, 2020, the facts and circumstances of which are adopted by reference herein, which declared both a Public Health Emergency and State of Emergency; and

     WHEREAS, through Executive Order Nos. 119 and 138 (2020), issued on April 7, 2020, and May 6, 2020, respectively, the facts and circumstances of which are adopted by reference herein, I declared that the COVID-19 Public Health Emergency continued to exist and declared that all Executive Orders and Administrative Orders adopted in whole or in part in response to the COVID-19 Public Health Emergency remained in full force and effect; and

     WHEREAS, in accordance with N.J.S.A. App. A:9-34 and -51, I reserve the right to utilize and employ all available resources of State government to protect against the emergency created by COVID-19; and

     WHEREAS, as of May 14, 2020, according to the Centers for Disease Control and Prevention (CDC), there were more than 4,248,000 confirmed cases of COVID-19 worldwide, with over 292,000 of those cases having resulted in death; and

     WHEREAS, as of May 14, 2020, there were more than 1,384,000 confirmed cases of COVID-19 in the United States, with over 83,000 of those cases having resulted in death; and

     WHEREAS, as of May 14, 2020, there were over 142,000 positive cases of COVID-19 in New Jersey, with at least 9,946 of those cases having resulted in death; and

     WHEREAS, on March 23, 2020, I issued Executive Order No. 109 (2020) which ordered that as of 5:00 p.m. on Friday, March 27, 2020, all "elective" surgeries performed on adults, whether medical or dental, and all "elective" invasive procedures performed on adults, whether medical or dental, would be suspended in New Jersey; and

     WHEREAS, an "elective" surgery or invasive procedure was defined as any surgery or invasive procedure that can be delayed without undue risk to the current or future health of the patient as determined by the patient's treating physician or dentist; and

     WHEREAS, this step was necessary at the time because hospitalizations, intensive care unit admissions, and ventilator usage were rapidly spiking, and these surgeries and procedures, whether undertaken in a hospital, ambulatory surgery center or provider office, necessarily draw upon the skill and time of critical health care professionals and involve the use of equipment and supplies that may be needed to treat those who are critically ill; and

     WHEREAS, the suspension of these surgeries and procedures preserved the capacity of our health care system to deal with the surge of COVID-19 cases, which reached its maximum impact on the health care system in the middle of April; and

     WHEREAS, over the last month, because of the social distancing measures that have been put in place, the rates of confirmed COVID-19 spread have decreased drastically; and

     WHEREAS, on April 4, the three-day average of new confirmed positive COVID-19 cases peaked at 4,064 cases, while by May 11, this three-day average had fallen to 1,572 new cases – a 61 percent decrease; and

     WHEREAS, the decreased rates of confirmed spread of COVID-19 resulted in fewer individuals seeking COVID-19-related emergency medical care; and

     WHEREAS, on April 10, the three-day average of new COVID-19 hospitalizations peaked at 869 new patient hospitalizations, while by May 11, this three-day average had fallen to 250 new patient hospitalizations – a 71 percent decrease; and

     WHEREAS, the decrease in new admissions to hospitals and the number of patients who have recoveries enabling them to leave the hospital has resulted in an overall decrease in the number of COVID-19 patients in hospitals; and

     WHEREAS, on April 15, the three-day average of patients in hospitals confirmed or suspected to have COVID-19 peaked at 8,226 patients, while by May 11, this three-day average had fallen to 4,277 patients – a 48 percent decrease; and

     WHEREAS, on April 15, the three-day average of patients confirmed or suspected to have COVID-19 receiving intensive or critical care peaked at 2,015 patients, while by May 11, this three-day average had fallen to 1,300 patients – a 36 percent decrease; and

     WHEREAS, on April 15, the three-day average of patients confirmed or suspected to have COVID-19 on a ventilator peaked at 1,659 patients, while by May 11, this three-day average had fallen to 982 patients – a 41 percent decrease; and

     WHEREAS, elective surgeries or invasive procedures, which by definition do not have to happen immediately, may still be necessary for patients' health; and

     WHEREAS, the decreasing burden on our health care system from COVID-19 means that elective surgeries or invasive procedures can be reasonably resumed, subject to limitations and precautions that would not be necessary but for the continued effects of the COVID-19 pandemic; and

     WHEREAS, the Constitution and statutes of the State of New Jersey, particularly the provisions of N.J.S.A. 26:13-1 et seq., N.J.S.A. App. A: 9-33 et seq., N.J.S.A. 38A:3-6.1, and N.J.S.A. 38A:2-4 and all amendments and supplements thereto, confer upon the Governor of the State of New Jersey certain emergency powers, which I have invoked;

     NOW, THEREFORE, I, PHILIP D. MURPHY, Governor of the State of New Jersey, by virtue of the authority vested in me by the Constitution and by the Statutes of this State, do hereby ORDER and DIRECT:

     1. Beginning at 5:00 a.m. on Tuesday, May 26, 2020, the suspension on elective surgeries and invasive procedures instituted in Executive Order No. 109 (2020) is rescinded.

     2. Elective surgeries and invasive procedures, as defined by Executive Order No. 109 (2020), may proceed at health care facilities, subject to limitations and precautions set forth in policies, which may include but are not limited to Executive Directives, to be issued by the Department of Health, in consultation with the Division of Consumer Affairs, by Monday, May 18, 2020. The policies to be issued by the Department of Health will address relevant considerations, such as the following:

     a. Which types of facilities can resume these procedures;

     b. Which specific facilities are eligible to resume these procedures, based upon their current or potential capacity;

     c. Whether facilities will be required to prioritize certain procedures, and if so, what considerations should guide these decisions;

     d. Personal Protective Equipment requirements for facilities that resume these procedures;

     e. Staffing requirements for facilities that resume these procedures;

     f. Whether facilities should cohort COVID-19 and non-COVID-19 patients;

     g. Requirements for patients seeking these procedures to undergo testing, self-quarantine, or other preventive measures, as applicable;

     h. Policies surrounding visitors;

     i. Policies surrounding discharge of patients after the procedures are completed; and

     j. Reporting metrics regarding the resumption of these procedures.

     3. Elective surgeries and invasive procedures, as defined by Executive Order No. 109 (2020), performed by licensed health care providers practicing in outpatient settings not licensed by the Department of Health (e.g., health care professional offices, clinics, and urgent care centers) may proceed, subject to limitations and precautions set forth in policies, which may include but are not limited to rules and administrative orders, to be issued by the Division of Consumer Affairs, in consultation with the Department of Health, by Monday, May 18, 2020. The policies to be issued by the Division of Consumer Affairs will address relevant considerations, such as the following:

     a. The categories of licensed health care providers who may resume these procedures;

     b. Whether licensed health care providers in outpatient settings will be required to prioritize certain procedures, and if so, what considerations should guide these decisions;

     c. Personal Protective Equipment requirements for outpatient settings where such procedures are resumed;

     d. Staffing requirements for outpatient settings where such procedures are resumed;

     e. How licensed health care providers and outpatient settings can minimize person-to-person contact and facilitate social distancing;

     f. Requirements for patients seeking these procedures to undergo testing, self-quarantine, or other preventive measures, as applicable;

     g. Policies surrounding companions;

     h. Policies surrounding patient follow-up after the procedures are completed; and

     i. Recordkeeping and reporting requirements.

     4. The Department of Health and / or the Division of Consumer Affairs may issue supplemental or amended policies concerning elective surgeries and elective invasive procedures on or after Monday, May 18, 2020, which shall be similarly enforceable, or rescind such policies at a later date.

     5. Any actions taken by the Commissioner of the Department of Health and / or the Director of the Division of Consumer Affairs pursuant to this Order shall not be subject to the requirements of the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq.

     6. It shall be the duty of every person or entity in this State or doing business in this State and of the members of the governing body and every official, employee, or agent of every political subdivision in this State and of each member of all other governmental bodies, agencies, and authorities in this State of any nature whatsoever, to cooperate fully in all matters concerning this Order.

     7. Penalties for violations of this Order may be imposed under, among other statutes, N.J.S.A. App. A:9-49 and -50.

     8. This Order shall take effect immediately. GIVEN, under my hand and seal this 15th day of May, Two Thousand and Twenty, and of the Independence of the United States, the Two Hundred and Forty-Fourth.

     [seal]

     / s / Philip D. Murphy
     Governor
Questions? Contact Jeff Shanton at  jshanton@jssurgctr.com